Documents Needed from Prospective Visiting Junior Fellow to Request J-1 Visa Sponsorship
Please complete all of the forms in this package and provide the additional documents listed below. The
completed checklist items should be sent at the same time to the departmental administrator who supports your
prospective UT Southwestern mentor/supervisor. For information or assistance with the application materials
contact the Office of International Affairs at InternationalAffairsOIA@utsouthwestern.edu , or call 214-648-0010.
You will find important information about the visa process, housing, international student/scholar organization
contact information, and tips to facilitate your life as a new-comer to the Dallas area and to UT Southwestern on
the International Affairs website at www.utsouthwestern.edu/international .
Completed “J-1 Visa Application” form and “Supplement 1” for accompanying dependents
Copy of C.V. indicating that you are enrolled in a graduate degree program in your country
Copies of passport biographical page for you and your accompanying family members
Copy of highest foreign university degree (if any) with English translation if needed
If you have already received a foreign university degree provide a “credential equivalency
evaluation” to establish the equivalent U.S. academic degree. (See enclosed list of agencies that
will prepare this evaluation.)
Documentation that you have purchased minimum required health and medical evacuation and
repatriation insurance. (See enclosed “J-1 Health Insurance Policy” for details and suggested
providers.) You may wait until after your J-1 visa stamp is issued and you know your arrival date
to buy this insurance.
Documentation of financial support in the amount of at least $28,500 U.S. per year ($2,375 U.S.
per month.) This may be from a UT Southwestern mentor and/or external organization in your
country. (Personal funding is accepted for visits of three months or less, only.)
Completed “Research Trainee ‘Buddy’ Request” form if you wish to be matched with a fellow
country national who is already a trainee at UT Southwestern
Office of International Affairs, University of Texas Southwestern Medical Center
5323 Harry Hines Blvd., NL 3.252, Dallas, TX 75390-9011; 214-648-0010; InternationalAffairsOIA@utsouthwestern.edu
Last updated: 01/11/2016
J-1 Visa Application for Prospective UTSW International Visitor
Instructions: Type or print the information requested below and forward with other checklist items to the
departmental administrative contact for your future UT Southwestern sponsoring department.
SECTION I – PERSONAL INFORMATION
Family Name: ______________________________________
Gender:
Female ____ Male ____
Date of Birth:
Marital Status:
Given Name(s): _______________________________________________
Married ____
Month _______ Day ______ Year ________
Single ____
Highest Degree Earned: ___________________
City of Birth: ______________________________________________
Country of Birth: ____________________ Country of Legal Residence: __________________ Country of Citizenship: _______________
Home Country Occupation: ___________________________
Home Country Employer: ______________________________________
SECTION II—Current or Previous U.S. Immigration Status
Are you currently in the U.S.? ___Yes
___No
Have you ever held a J-1 visa in the U.S.: Yes ___
Select J-1 Category:
If “Yes,” what is your current US visa classification?: _____________________
No ____ If “Yes” Provide Start and End Date of J-1 Program: _______________
__ Student __ Student Intern __ Research Scholar __ Short Term Scholar __ Alien Physician Trainee __ Other
I have a valid ECFMG Certificate: Yes _____ No______
U.S. Social Security Number (if any): _________________
SECTION IV—FUNDING AND DEPARTMENTAL INFORMATION FOR UT SOUTHWESTERN VISIT
Faculty Member I will work with at UT Southwestern: _______________________ Department Name: __________________
I will receive funding from UT Southwestern:
Yes_____
No_____ If “Yes,” Provide Amount (U.S. Dollars):_____________
I will receive funding from another entity or organization outside of UT Southwestern:
Yes____
No_____
If “Yes,” provide name of entity or organization: _______________________________________________________________
Purpose for which entity/organization awarded the funds to you: _________________________________________________
The above funding provider is a government organization:
Yes____
No_____
I will visit UT Southwestern for 3 months or less and will be financed by personal funding:
Yes____
No_____
SECTION V—CONTACT INFORMATION, TRAVEL PLANS
Provide physical street address for Federal Express/courier delivery of visa document. (Please do not use a Post Office box address.)
Street Number and Name: ______________________________City: ____________________________________________________
Province: _________________________
Country: __________________
Telephone Number: ___________________________
Postal Code: ______________________
E-Mail Address: ______________________________________
Expected Date of Arrival: ________________ Expected Date of Departure: __________________
HEALTH INSURANCE COVERAGE—Mark the statement below that applies to your situation
___I agree to buy health insurance and “medical evacuation and repatriation insurance” that meets the requirement for J-1 visa holders for
myself/spouse/children.
___I agree to buy only “medical evacuation and repatriation” coverage for myself/spouse/children since I will be paid a full time salary by UT
Southwestern and will qualify for employee health insurance benefits.
I certify that the above information is accurate and I will comply with the health insurance requirements for J-1 visa holders and J-2 dependents
Signature: _____________________________________________________
Last updated: 11/13/2015
Date: ______________________
Supplement-1
Attach when more than one person is included in the petition or application.
(List each person separately. Do not include the person you named on the form.)
Updated 11/04/2015
Relation to J-1 Visitor
Family Name
Date of Birth (month/day/year)
Gender
Given/Other Names
City and Country of Birth
Country of Legal Permanent Residence
Health and Medical Evacuation and Repatriation Insurance for
Dependent:
If already purchased, provide name of Health Insurance
Company and Dates of Validity of Policy:
_______________________________________________
____Will be purchased on arrival in U.S.
Relation to J-1 Visitor
Family Name
___Already Purchased
Date of Birth (month/day/year)
Gender
Given/Other Names
City and Country of Birth
Country of Legal Permanent Residence
Health and Medical Evacuation and Repatriation Insurance for
Dependent:
If already purchased, provide name of Health Insurance
Company and Dates of Validity of Policy:
_______________________________________________
____Will be purchased on arrival in U.S.
Relation to J-1 Visitor
Family Name
___Already Purchased
Date of Birth (month/day/year)
Given Name
Gender
Middle Name
City and Country of Birth
Country of Legal Permanent Residence
Health and Medical Evacuation and Repatriation Insurance for
Dependent:
If already purchased, provide name of Health Insurance
Company and Dates of Validity of Policy:
____Will be purchased on arrival in U.S.
_______________________________________________
Relation to J-1 Visitor
Family Name
___Already Purchased
Date of Birth (month/day/year)
Given Name
City and Country of Birth
Gender
Middle Name
Country of Legal Permanent Residence
Health and Medical Evacuation and Repatriation Insurance for
Dependent:
If already purchased, provide name of Health Insurance
Company and Dates of Validity of Policy:
_______________________________________________
____Will be purchased on arrival in U.S.
___Already Purchased
Education Credential Evaluation Agencies
This page includes a partial listing of private companies who are authorized by the Bureau of
Citizenship and Immigration Services to provide evaluations of foreign educational degrees.
Many other companies in the U.S. have been authorized to provide these evaluations. Please
feel free to use any company you wish.
We recommend that you contact a few different companies to compare fees and processing
times. You will need to have only your highest degree evaluated. The evaluation does not need
to include a course-by-course evaluation, but simply an evaluation of the diploma itself.
Global Credential Evaluators, Inc.
P.O. Box 9203
College Station, TX 77842
Phone: 800-707-0979
Phone (International): 718-249-4855
Fax: 979-690-6342
gce@gceus.com
American Evaluation and Translation Service, Inc.
407 Lincoln Road, Suite 11-J
Miami Beach, FL 33139
Phone: 786-276-8190
Fax: 786- 524-0448, 786-524-3300 or 786-8701205
Email
Educational Credential Evaluators, Inc.
P.O. Box 92970
Milwaukee, WI 53202-0970
Phone: 414-289-3400
Fax: 414-289-3411
Foreign Credentials Service of America
1910 Justin Lane
Austin, TX 78757
Phone: 512-459-8428
Fax: 512-459-4565
Email
Josef Silny & Associates, Inc.
International Education Consultants
7101 SW 102 Avenue
Miami, FL 33173
Direct: 305-273-1616
Fax: 305-273-1338
Translation fax: 305-273-1984
World Education Services, Inc.
P.O. Box 745, Old Chelsea Station
New York, NY 10113-0745
Phone: 800-937-3895
Fax: 212-966-6395
Last updated: 11/04/2015
Office of International Affairs
Health Insurance Policy for J-1 “Students,” “Student Interns,” “Research Scholars,” “Professors,” and “Short
Term Scholars” Sponsored Under the UT Southwestern Exchange Visitor Visa Program
Effective date of policy: January 1, 2015
Policy revision date: June 1, 2015
Purpose of Policy:
Ensure J-1/J-2 visa holders sponsored by UT Southwestern maintain health insurance and medical evacuation and
repatriation insurance that meets State Department regulations and is compliant with the Affordable Care Act.
Summary of the Requirement:
The U.S. Department of State J-1 Exchange Visitor regulations require that all J-1 Exchange Visitors and their J-2
dependents maintain valid major Medical, Medical Evacuation, and Repatriation of Remains Insurance during the period
of J status as outlined on the Form DS-2019. In 2015, the minimum mandatory insurance coverage amounts for each J-1
visa holder and J-2 dependent will increase in 2015 to:
1.
2.
3.
4.
5.
Medical benefits of at least US$100,000 per accident or illness
A deductible (the amount for which you are responsible) not to exceed US$500 per accident or illness
Repatriation of remains coverage in the amount of US$25,000
Expenses to cover medical evacuation of the visitor(s) to the home country in the amount of US$50,000
Underwritten by an insurance corporation having a rating that meets Department of State requirements,
Backed by the full faith and credit of the government of the exchange visitor’s home country, or part of a health benefits
program offered on a group basis to employees or enrolled students by a designated sponsor
NOTE: J-1 exchange visitors who meet rules of the Internal Revenue Service to be treated as U.S. residents for tax purposes may be
subject to tax penalties unless they purchase health insurance that is compliant with the “Affordable Care Act.”
Willful failure to comply with this requirement will result in the termination of the exchange visitor’s program. To
avoid termination of ‘J’ sponsorship, it is critical that this mandatory compliance requirement be met. Guidelines for
meeting the requirement are provided below:
1. All J-1 visa holders and their J-2 dependents in the U.S. must purchase “medical evacuation and repatriation”
coverage as indicated above.
2. All J-1 exchange visitors and their J-2 dependents in the U.S. must secure health insurance through one of the
following options:
a. Employee health insurance benefits plan offered by UT Southwestern or an affiliated hospital*
b. UT System student coverage offered through Academic Health Plans*
c. Health insurance coverage that meets the above requirements; some examples are listed at
http://www.nafsa.org/Find_Resources/Supporting_International_Students_And_Scholars/Network_Res
ources/International_Enrollment_Management/Health_Insurance_Companies/
d. A health insurance policy meeting the above requirements that is backed by the full faith and credit of
your home country government
*These policies meet requirements of the “Affordable Care Act”
Last Updated: 12/17/2015
Office of International Affairs
Comparison of Key Elements of Coverage for Three Different Health Insurance Providers:
Type of Coverage
UT Select Employee Plan
Academic Health Plans
COMPASS Care International
(Example only--see COMPASS link
below for cost by age of applicant)
Pre-existing conditions (e.g.
diabetes, pregnancy, chronic
health conditions)
Yes
Yes
No
Premium Sharing (employer
pays all or part of cost)
Yes
No
No
Dental Coverage Available for
an Additional Fee
Yes
Yes
No
100% UTSW Employee
$0/month
$182/ month
$58 (for scholar aged 31-40);
deductible of $500
50-99% UTSW employee
$263.70/ month
<50% UTSW Employee
$527.40/ month
100% UTSW employee
$227.07/ month
$512/ month
$258
50-99% employee
$629.01/ month
<50% employee
$1030.95/ month
100% UTSW employee
$237.49/ month
$282/ month
$56.40 for each child
50-99% employee
$589.64/ month
<50% employee
$941.79/ month
100% UTSW employee
$447.17/ month
50-99% employee
$938.38/ month
<50% employee
$1429.59/ month
Varies; check with doctor or
facility
Varies; check with doctor or facility
Monthly Premium for single
employee
Monthly Premium for Spouse
Monthly Premium for Children
Employee & Family
Percentage of UT
Southwestern
Employment
Doctor/Facility will send your
bill to insurance company
Usually; check with
doctor or facility
Coverage Period
Start date to end date of
employment
Academic Semester or Year
Method of Payment
Monthly Installments
withheld from pay check
Enrolled students: monthly
installment plan; Scholars pay
in advance.
Affordable Care Act Compliant?
Yes
Yes
15 days – 12 months; renewable
Payment required in advance, but
may be purchased in increments of
several months and renewed
required period
No
More Information:
UT Select Employee Health Insurance – http://www.utsystem.edu/offices/employee-benefits/active-employee-insurance
Academic Health Plans— https://utsouthwestern.myahpcare.com/benefits
COMPAS Care Student & Scholar Policy-- http://compassstudenthealthinsurance.com/compare_international_insurance_plans.php
Last Updated: 12/17/2015
Submit by Email
Complete this Form to Request an International ‘Buddy’
Please complete each field below to help us select an International “Buddy” to help answer your questions and offer
suggestions about working at UT Southwestern or living in Dallas, TX. Print and scan the completed form and send it
together with your visa application materials to the departmental administrative contact for your prospective mentor.
Family Name:
Gender:
Given
Female
Name:
Middle Name:
Male E-Mail:
Telephone#:
Please Provide the Following Information From Your UT Southwestern Offer Letter:
Name of UT Southwestern Postdoc Mentor:
UT Southwestern Department Where You Will Work:
UT Southwestern Job Title:
_____________________________
Will You Be Coming With Family Members? If Yes:
Country of Birth:
Spouse?
Children? Age of Children?:
Country of Current Residence (if different):
Your Expected Date of Arrival at UT Southwestern:
What is Your First Language?:
Other Languages?:
Religious Affiliation, If Any:
Would You Prefer a “Buddy” of the Same Religious Affiliation, If Available?
YES
NOT IMPORTANT
Would You Prefer a “Buddy” Who (Mark Any That Apply):
Is of the Same Nationality?
Speaks the Same Language?
Is American?
List Any Other Preferences:
Please List Your Hobbies or Favorite Activities (Optional)
Is There Anything Else You Would Like to Tell Us About Yourself? (Optional)
When your completed form is received, the Office of International Affairs will review and identify and communicate to you the
name and business email address of a current research trainee whom you may contact.
We look forward to welcoming you to UT Southwestern!
Office of International Affairs, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas,
TX 75390-9011; Telephone: 214-648-0010; Fax: 214-648-4150; Website:
http://www.utsouthwestern.edu/international